Susan Diane Trimble, LPTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

116757 Issued in MO

Practice address

15822 Clayton Rd
Ellisville, MO 63011-2212

Phone

(636) 220-1681

NPI assigned

Aug 13, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Healthcare Services

  • Clinic/Center
  • Ellisville, MO
  • NPI 1699131573
  NPD (past)
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628812800000",
    "number": "1194490938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 SPRING PARK DR",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633036491",
            "telephone_number": "314-606-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15822 CLAYTON RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112212",
            "telephone_number": "636-220-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIMBLE",
        "first_name": "SUSAN",
        "middle_name": "DIANE",
        "credential": "LPTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-13",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "116757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Jean Tavernor, M.S.
• Taylored Therapies, PLLC
• The Koetting Associates Inc.
• April Jean Toornstra, PTA
• Touch by Amour Home Health LLC
• Tybar Medical, LLC
• US Surgical Partners LLC
• US Surgical Partners, LLC
• Usrc Ellisville LLC
• James Edward Vandewater, DMD

• Physical Therapy Assistant in Ellisville, MO
• Providers in Ellisville, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.